Glucagon‐like peptide‐1 receptor agonists for antipsychotic‐associated cardio‐metabolic risk factors: A systematic review and individual participant data meta‐analysis
Aims To evaluate if glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) reduce antipsychotic‐associated body weight gain in patients with schizophrenia, when compared to controls. Materials and methods We systematically searched PubMed/EMBASE/PsycINFO/Cochrane using the search terms ‘(antipsychotic...
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creator | Siskind, Dan Hahn, Margaret Correll, Christoph U. Fink‐Jensen, Anders Russell, Anthony W. Bak, Nikolaj Broberg, Brian V. Larsen, Julie Ishøy, Pelle L. Vilsbøll, Tina Knop, Filip K. Kisely, Steve Ebdrup, Bjørn H. |
description | Aims
To evaluate if glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) reduce antipsychotic‐associated body weight gain in patients with schizophrenia, when compared to controls.
Materials and methods
We systematically searched PubMed/EMBASE/PsycINFO/Cochrane using the search terms ‘(antipsychotic and GLP‐1RA)’. Individual participant data from studies randomizing patients to GLP‐1RA or control were meta‐analysed. The primary outcome was difference in body weight between GLP‐1RA and control; secondary outcomes included cardio‐metabolic variables and adverse drug reactions (ADRs). Multiple linear regression was conducted including sex, age, psychosis severity, metabolic variable, ADRs, and GLP‐1RA agent.
Results
Three studies (exenatide once‐weekly = 2; liraglutide once‐daily = 1) provided participant‐level data (n = 164, age = 40.0 ± 11.1 years, body weight = 105.8 ± 20.8 kg). After 16.2 ± 4.0 weeks of treatment, body weight loss was 3.71 kg (95% CI = 2.44‐4.99 kg) greater for GLP‐1RA versus control (p < 0.001), number‐needed‐to‐treat ≥5% body weight loss = 3.8 (95% CI = 2.6‐7.2). Waist circumference, body mass index, HbA1c, fasting glucose and visceral adiposity were each significantly lower with GLP‐1RA. Sex, age, psychosis severity, nausea, any ADR, and GLP‐1RA agent did not significantly impact outcomes. Body weight loss with GLP‐1RAs was greater for clozapine/olanzapine‐treated patients (n = 141) than other antipsychotics (n = 27) (4.70 kg, 95% CI = 3.13‐6.27 vs. 1.5 kg, 95% CI = −1.47‐4.47) (p < 0.001). Nausea was more common with GLP‐1RAs than control (53.6% vs. 27.5%, p = 0.002, number‐needed‐to‐harm = 3.8).
Conclusion
GLP‐1RAs are effective and tolerable for antipsychotic‐associated body weight gain, particularly clozapine/olanzapine‐treated patients. With few included patients, further studies are required before making routine use recommendations for GLP‐1RAs. |
doi_str_mv | 10.1111/dom.13522 |
format | Article |
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To evaluate if glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) reduce antipsychotic‐associated body weight gain in patients with schizophrenia, when compared to controls.
Materials and methods
We systematically searched PubMed/EMBASE/PsycINFO/Cochrane using the search terms ‘(antipsychotic and GLP‐1RA)’. Individual participant data from studies randomizing patients to GLP‐1RA or control were meta‐analysed. The primary outcome was difference in body weight between GLP‐1RA and control; secondary outcomes included cardio‐metabolic variables and adverse drug reactions (ADRs). Multiple linear regression was conducted including sex, age, psychosis severity, metabolic variable, ADRs, and GLP‐1RA agent.
Results
Three studies (exenatide once‐weekly = 2; liraglutide once‐daily = 1) provided participant‐level data (n = 164, age = 40.0 ± 11.1 years, body weight = 105.8 ± 20.8 kg). After 16.2 ± 4.0 weeks of treatment, body weight loss was 3.71 kg (95% CI = 2.44‐4.99 kg) greater for GLP‐1RA versus control (p < 0.001), number‐needed‐to‐treat ≥5% body weight loss = 3.8 (95% CI = 2.6‐7.2). Waist circumference, body mass index, HbA1c, fasting glucose and visceral adiposity were each significantly lower with GLP‐1RA. Sex, age, psychosis severity, nausea, any ADR, and GLP‐1RA agent did not significantly impact outcomes. Body weight loss with GLP‐1RAs was greater for clozapine/olanzapine‐treated patients (n = 141) than other antipsychotics (n = 27) (4.70 kg, 95% CI = 3.13‐6.27 vs. 1.5 kg, 95% CI = −1.47‐4.47) (p < 0.001). Nausea was more common with GLP‐1RAs than control (53.6% vs. 27.5%, p = 0.002, number‐needed‐to‐harm = 3.8).
Conclusion
GLP‐1RAs are effective and tolerable for antipsychotic‐associated body weight gain, particularly clozapine/olanzapine‐treated patients. With few included patients, further studies are required before making routine use recommendations for GLP‐1RAs.</description><identifier>ISSN: 1462-8902</identifier><identifier>EISSN: 1463-1326</identifier><identifier>DOI: 10.1111/dom.13522</identifier><identifier>PMID: 30187620</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adipose tissue ; Age ; Antipsychotics ; Body mass index ; Body weight gain ; Body weight loss ; cardiovascular risk ; Clozapine ; Data processing ; Evidence-based medicine ; GLP‐1RAs ; Glucagon ; Mental disorders ; Meta-analysis ; Metabolism ; Nausea ; Obesity ; Olanzapine ; Patients ; Peptides ; Psychosis ; Psychotropic drugs ; Risk factors ; Schizophrenia ; Systematic review</subject><ispartof>Diabetes, obesity & metabolism, 2019-02, Vol.21 (2), p.293-302</ispartof><rights>2018 John Wiley & Sons Ltd</rights><rights>2018 John Wiley & Sons Ltd.</rights><rights>2019 John Wiley & Sons Ltd</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3532-229721fb6d8554a0d18bf8d8aee954da587ec2a2b62ebfd0a4527cbd4b3eda9d3</citedby><cites>FETCH-LOGICAL-c3532-229721fb6d8554a0d18bf8d8aee954da587ec2a2b62ebfd0a4527cbd4b3eda9d3</cites><orcidid>0000-0003-4021-2924 ; 0000-0001-8884-9946 ; 0000-0002-2072-9216 ; 0000-0002-2590-5055</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdom.13522$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdom.13522$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,27933,27934,45583,45584</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30187620$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Siskind, Dan</creatorcontrib><creatorcontrib>Hahn, Margaret</creatorcontrib><creatorcontrib>Correll, Christoph U.</creatorcontrib><creatorcontrib>Fink‐Jensen, Anders</creatorcontrib><creatorcontrib>Russell, Anthony W.</creatorcontrib><creatorcontrib>Bak, Nikolaj</creatorcontrib><creatorcontrib>Broberg, Brian V.</creatorcontrib><creatorcontrib>Larsen, Julie</creatorcontrib><creatorcontrib>Ishøy, Pelle L.</creatorcontrib><creatorcontrib>Vilsbøll, Tina</creatorcontrib><creatorcontrib>Knop, Filip K.</creatorcontrib><creatorcontrib>Kisely, Steve</creatorcontrib><creatorcontrib>Ebdrup, Bjørn H.</creatorcontrib><title>Glucagon‐like peptide‐1 receptor agonists for antipsychotic‐associated cardio‐metabolic risk factors: A systematic review and individual participant data meta‐analysis</title><title>Diabetes, obesity & metabolism</title><addtitle>Diabetes Obes Metab</addtitle><description>Aims
To evaluate if glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) reduce antipsychotic‐associated body weight gain in patients with schizophrenia, when compared to controls.
Materials and methods
We systematically searched PubMed/EMBASE/PsycINFO/Cochrane using the search terms ‘(antipsychotic and GLP‐1RA)’. Individual participant data from studies randomizing patients to GLP‐1RA or control were meta‐analysed. The primary outcome was difference in body weight between GLP‐1RA and control; secondary outcomes included cardio‐metabolic variables and adverse drug reactions (ADRs). Multiple linear regression was conducted including sex, age, psychosis severity, metabolic variable, ADRs, and GLP‐1RA agent.
Results
Three studies (exenatide once‐weekly = 2; liraglutide once‐daily = 1) provided participant‐level data (n = 164, age = 40.0 ± 11.1 years, body weight = 105.8 ± 20.8 kg). After 16.2 ± 4.0 weeks of treatment, body weight loss was 3.71 kg (95% CI = 2.44‐4.99 kg) greater for GLP‐1RA versus control (p < 0.001), number‐needed‐to‐treat ≥5% body weight loss = 3.8 (95% CI = 2.6‐7.2). Waist circumference, body mass index, HbA1c, fasting glucose and visceral adiposity were each significantly lower with GLP‐1RA. Sex, age, psychosis severity, nausea, any ADR, and GLP‐1RA agent did not significantly impact outcomes. Body weight loss with GLP‐1RAs was greater for clozapine/olanzapine‐treated patients (n = 141) than other antipsychotics (n = 27) (4.70 kg, 95% CI = 3.13‐6.27 vs. 1.5 kg, 95% CI = −1.47‐4.47) (p < 0.001). Nausea was more common with GLP‐1RAs than control (53.6% vs. 27.5%, p = 0.002, number‐needed‐to‐harm = 3.8).
Conclusion
GLP‐1RAs are effective and tolerable for antipsychotic‐associated body weight gain, particularly clozapine/olanzapine‐treated patients. With few included patients, further studies are required before making routine use recommendations for GLP‐1RAs.</description><subject>Adipose tissue</subject><subject>Age</subject><subject>Antipsychotics</subject><subject>Body mass index</subject><subject>Body weight gain</subject><subject>Body weight loss</subject><subject>cardiovascular risk</subject><subject>Clozapine</subject><subject>Data processing</subject><subject>Evidence-based medicine</subject><subject>GLP‐1RAs</subject><subject>Glucagon</subject><subject>Mental disorders</subject><subject>Meta-analysis</subject><subject>Metabolism</subject><subject>Nausea</subject><subject>Obesity</subject><subject>Olanzapine</subject><subject>Patients</subject><subject>Peptides</subject><subject>Psychosis</subject><subject>Psychotropic drugs</subject><subject>Risk factors</subject><subject>Schizophrenia</subject><subject>Systematic review</subject><issn>1462-8902</issn><issn>1463-1326</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kctu1jAQRi0EohdY8ALIEpt2kdaX3H52VaEFqVU3sI4m9gTcJnHwOK2y4xF4FV6JJ6nTv7BAqjf2eI7OWP4YeyPFkUzr2PrhSOpCqWdsV-alzqRW5fOHs8rqjVA7bI_oWgiR67p6yXa0kHVVKrHLfp_3s4Fvfvzz81fvbpBPOEVnMZWSBzSp8oGvgKNIvFuLMbqJFvPdR2cSB0TeOIhouYFgnU93A0Zofe8MD45ueAcmaeg9P-G0UMQB4trCW4d3yWe5G627dXaGnk8QUtNNaQy3EIGvrnXMCP1Cjl6xFx30hK8f93329ezjl9NP2cXV-efTk4vM6EKrTKlNpWTXlrYuihyElXXb1bYGxE2RWyjqCo0C1ZYK284KyAtVmdbmrUYLG6v32cHWOwX_Y0aKzeDIYN_DiH6mRkkhtE4_XSX03X_otZ9Deu9KlaXQUlZ1og63lAmeKGDXTMENEJZGimbNsUk5Ng85Jvbto3FuB7T_yL_BJeB4C9y5HpenTc2Hq8ut8h66vbDy</recordid><startdate>201902</startdate><enddate>201902</enddate><creator>Siskind, Dan</creator><creator>Hahn, Margaret</creator><creator>Correll, Christoph U.</creator><creator>Fink‐Jensen, Anders</creator><creator>Russell, Anthony W.</creator><creator>Bak, Nikolaj</creator><creator>Broberg, Brian V.</creator><creator>Larsen, Julie</creator><creator>Ishøy, Pelle L.</creator><creator>Vilsbøll, Tina</creator><creator>Knop, Filip K.</creator><creator>Kisely, Steve</creator><creator>Ebdrup, Bjørn H.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4021-2924</orcidid><orcidid>https://orcid.org/0000-0001-8884-9946</orcidid><orcidid>https://orcid.org/0000-0002-2072-9216</orcidid><orcidid>https://orcid.org/0000-0002-2590-5055</orcidid></search><sort><creationdate>201902</creationdate><title>Glucagon‐like peptide‐1 receptor agonists for antipsychotic‐associated cardio‐metabolic risk factors: A systematic review and individual participant data meta‐analysis</title><author>Siskind, Dan ; Hahn, Margaret ; Correll, Christoph U. ; Fink‐Jensen, Anders ; Russell, Anthony W. ; Bak, Nikolaj ; Broberg, Brian V. ; Larsen, Julie ; Ishøy, Pelle L. ; Vilsbøll, Tina ; Knop, Filip K. ; Kisely, Steve ; Ebdrup, Bjørn H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3532-229721fb6d8554a0d18bf8d8aee954da587ec2a2b62ebfd0a4527cbd4b3eda9d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adipose tissue</topic><topic>Age</topic><topic>Antipsychotics</topic><topic>Body mass index</topic><topic>Body weight gain</topic><topic>Body weight loss</topic><topic>cardiovascular risk</topic><topic>Clozapine</topic><topic>Data processing</topic><topic>Evidence-based medicine</topic><topic>GLP‐1RAs</topic><topic>Glucagon</topic><topic>Mental disorders</topic><topic>Meta-analysis</topic><topic>Metabolism</topic><topic>Nausea</topic><topic>Obesity</topic><topic>Olanzapine</topic><topic>Patients</topic><topic>Peptides</topic><topic>Psychosis</topic><topic>Psychotropic drugs</topic><topic>Risk factors</topic><topic>Schizophrenia</topic><topic>Systematic review</topic><toplevel>online_resources</toplevel><creatorcontrib>Siskind, Dan</creatorcontrib><creatorcontrib>Hahn, Margaret</creatorcontrib><creatorcontrib>Correll, Christoph U.</creatorcontrib><creatorcontrib>Fink‐Jensen, Anders</creatorcontrib><creatorcontrib>Russell, Anthony W.</creatorcontrib><creatorcontrib>Bak, Nikolaj</creatorcontrib><creatorcontrib>Broberg, Brian V.</creatorcontrib><creatorcontrib>Larsen, Julie</creatorcontrib><creatorcontrib>Ishøy, Pelle L.</creatorcontrib><creatorcontrib>Vilsbøll, Tina</creatorcontrib><creatorcontrib>Knop, Filip K.</creatorcontrib><creatorcontrib>Kisely, Steve</creatorcontrib><creatorcontrib>Ebdrup, Bjørn H.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetes, obesity & metabolism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Siskind, Dan</au><au>Hahn, Margaret</au><au>Correll, Christoph U.</au><au>Fink‐Jensen, Anders</au><au>Russell, Anthony W.</au><au>Bak, Nikolaj</au><au>Broberg, Brian V.</au><au>Larsen, Julie</au><au>Ishøy, Pelle L.</au><au>Vilsbøll, Tina</au><au>Knop, Filip K.</au><au>Kisely, Steve</au><au>Ebdrup, Bjørn H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Glucagon‐like peptide‐1 receptor agonists for antipsychotic‐associated cardio‐metabolic risk factors: A systematic review and individual participant data meta‐analysis</atitle><jtitle>Diabetes, obesity & metabolism</jtitle><addtitle>Diabetes Obes Metab</addtitle><date>2019-02</date><risdate>2019</risdate><volume>21</volume><issue>2</issue><spage>293</spage><epage>302</epage><pages>293-302</pages><issn>1462-8902</issn><eissn>1463-1326</eissn><abstract>Aims
To evaluate if glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) reduce antipsychotic‐associated body weight gain in patients with schizophrenia, when compared to controls.
Materials and methods
We systematically searched PubMed/EMBASE/PsycINFO/Cochrane using the search terms ‘(antipsychotic and GLP‐1RA)’. Individual participant data from studies randomizing patients to GLP‐1RA or control were meta‐analysed. The primary outcome was difference in body weight between GLP‐1RA and control; secondary outcomes included cardio‐metabolic variables and adverse drug reactions (ADRs). Multiple linear regression was conducted including sex, age, psychosis severity, metabolic variable, ADRs, and GLP‐1RA agent.
Results
Three studies (exenatide once‐weekly = 2; liraglutide once‐daily = 1) provided participant‐level data (n = 164, age = 40.0 ± 11.1 years, body weight = 105.8 ± 20.8 kg). After 16.2 ± 4.0 weeks of treatment, body weight loss was 3.71 kg (95% CI = 2.44‐4.99 kg) greater for GLP‐1RA versus control (p < 0.001), number‐needed‐to‐treat ≥5% body weight loss = 3.8 (95% CI = 2.6‐7.2). Waist circumference, body mass index, HbA1c, fasting glucose and visceral adiposity were each significantly lower with GLP‐1RA. Sex, age, psychosis severity, nausea, any ADR, and GLP‐1RA agent did not significantly impact outcomes. Body weight loss with GLP‐1RAs was greater for clozapine/olanzapine‐treated patients (n = 141) than other antipsychotics (n = 27) (4.70 kg, 95% CI = 3.13‐6.27 vs. 1.5 kg, 95% CI = −1.47‐4.47) (p < 0.001). Nausea was more common with GLP‐1RAs than control (53.6% vs. 27.5%, p = 0.002, number‐needed‐to‐harm = 3.8).
Conclusion
GLP‐1RAs are effective and tolerable for antipsychotic‐associated body weight gain, particularly clozapine/olanzapine‐treated patients. With few included patients, further studies are required before making routine use recommendations for GLP‐1RAs.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>30187620</pmid><doi>10.1111/dom.13522</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-4021-2924</orcidid><orcidid>https://orcid.org/0000-0001-8884-9946</orcidid><orcidid>https://orcid.org/0000-0002-2072-9216</orcidid><orcidid>https://orcid.org/0000-0002-2590-5055</orcidid></addata></record> |
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subjects | Adipose tissue Age Antipsychotics Body mass index Body weight gain Body weight loss cardiovascular risk Clozapine Data processing Evidence-based medicine GLP‐1RAs Glucagon Mental disorders Meta-analysis Metabolism Nausea Obesity Olanzapine Patients Peptides Psychosis Psychotropic drugs Risk factors Schizophrenia Systematic review |
title | Glucagon‐like peptide‐1 receptor agonists for antipsychotic‐associated cardio‐metabolic risk factors: A systematic review and individual participant data meta‐analysis |
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